9/2/2014 1 Post-Arthroscopic Rehabilitation of the Hip Steve Clark, PT, ATC, DPT, MS, CSCS Physical Therapist/Athletic Trainer • Hip Arthroscopy menu • Rehabilitation phases – Goals – Precautions – Activity & exercise interventions – Criteria for advancement • Return to activity Outline Types of Arthroscopic Surgery Hip Arthroscopy Osteoplasty Rim Trimming Chondroplasty Osteoplasty Microfracture Acetabular Labral Repair Capsular Plication and Closure Phases of Rehab • PHASE I – Immediate Weeks: 1 – 4 • 6-8 weeks if microfx • Maximum Protection and Mobility • PHASE II - Intermediate Weeks: 4 - 10 • Gait • Controlled Stability • Closed Chain Activity Phases of Rehab • PHASE III – Advanced Weeks: 10 - 16 • Strengthening • PHASE IV – Return to Function Progression Weeks: 16 – beyond • Activity Specific • Return to sport test – ~16-20 weeks Immediate Exercises: PHASE I Maximum Protection and Mobility Weeks 1 – 4 (6-8 weeks microfx) Goals – Protect integrity of repaired tissues – Diminish pain and inflammation – Restore passive range of motion within restriction – Prevent muscular inhibition – Patient education Precautions – Specific ranges of motion (based on restrictions) – Weight bearing activity (based on restrictions) – Hip pain and pinching
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9/2/2014
1
Post-Arthroscopic Rehabilitation
of the Hip
Steve Clark, PT, ATC, DPT, MS, CSCS
Physical Therapist/Athletic Trainer
• Hip Arthroscopy menu
• Rehabilitation phases
– Goals
– Precautions
– Activity & exercise interventions
– Criteria for advancement
• Return to activity
Outline
Types of Arthroscopic Surgery
Hip Arthroscopy
Osteoplasty
Rim Trimming
Chondroplasty
OsteoplastyMicrofracture
Acetabular
Labral Repair
Capsular Plication
and Closure
Phases of Rehab
• PHASE I – Immediate
Weeks: 1 – 4
• 6-8 weeks if microfx
• Maximum Protection and Mobility
• PHASE II - Intermediate
Weeks: 4 - 10
• Gait
• Controlled Stability
• Closed Chain Activity
Phases of Rehab
• PHASE III – Advanced
Weeks: 10 - 16
• Strengthening
• PHASE IV – Return to Function Progression
Weeks: 16 – beyond
• Activity Specific
• Return to sport test
– ~16-20 weeks
Immediate Exercises: PHASE I Maximum Protection and Mobility
Weeks 1 – 4 (6-8 weeks microfx)
Goals– Protect integrity of repaired tissues
– Diminish pain and inflammation
– Restore passive range of motion within restriction
– Prevent muscular inhibition
– Patient education
Precautions– Specific ranges of motion (based on restrictions)
– Weight bearing activity (based on restrictions)
– Hip pain and pinching
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Osteoplasty Chondroplasty MicrofractureAcetabular
Labral Repair
Capsular
Plication
Weightbearing FFWB (≈20 lbs or 1/6 BW)
Flexion 90° x 10 Days 120°: 21 D
Extension Gentle x 10 D 0° x 3 Weeks >0° after 21 D
External Rot Gentle x 3 Wks 0° x 3 Weeks 0° x 21 D
Internal Rot No Limit
Abduction 25° x 3 Wks 35° x 3 Weeks 45° x 2 Wks
Bledsoe Brace 0 - 90° x 10 Days 0-105° x 21 D
Range of Motion LimitationsBased on Procedure and Post Operative Prescription Devices for ROM Restriction
Bledsoe brace Anti-rotation boots
PROM
• Circumduction, circumduction, cir……
• CPM
More little ex.
• Tummy time
• Opposite knee to chest/post. pelvic tilt
Immediate Exercises: PHASE I Maximum Protection and Mobility
• Stationary bike with min resistance
– Upright posture to ↓ flexion
– Gait progression – crutch weaning as appropriate
– Foot straps
• Stretches
– Posterior chain – hamstrings, gastroc/soleus
– Piriformis w/o ER
Immediate Exercises: PHASE I Maximum Protection and Mobility
Immediate Exercises: PHASE I Maximum Protection and Mobility
• Exercises
– Quadruped rocking
– Isometrics – abd, add, glute squeezes
• Prone heel squeezes
– Active prone IR – stool rotations
– Clamshells/ closed when approp.
– Heel slides
• Careful w/ active hip flexion as able
Immediate Exercises: PHASE I Maximum Protection and Mobility
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Immediate Exercises: PHASE I Maximum Protection and Mobility: Quadruped Rolling
Immediate Exercises: PHASE I Maximum Protection and Mobility: Clamshells & Lat Raise
Note ROM limits
Immediate Exercises: PHASE I Maximum Protection and Mobility: Glute Bridges
Immediate Exercises: PHASE I Maximum Protection and Mobility: Heel Squeeze, Side Plank
Immediate Exercises: PHASE I Maximum Protection and Mobility: Inverted Clam Shells
Immediate Exercises: PHASE I Maximum Protection and Mobility: Inverted Clam Shells
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Immediate Exercises: PHASE I Maximum Protection and Mobility
Progression Criteria to Phase 2: Controlled Stabilization
• Minimal pain with all phase I exercise
• ROM ≥75% of the uninvolved side
• Proper muscle firing patterns for initial exercises
• Do not progress to phase II until full weight bearing is allowed
• Phase 1 and 2 overlap
• Late Phase 1 � Phase 2
Stick Series/Hip Hinge
• still 50% WB
Immediate Exercises: PHASE I Maximum Protection and Mobility: Stick Series
Immediate Exercises: PHASE I Maximum Protection and Mobility: x3 Pts of Contact
Immediate Exercises: PHASE I Maximum Protection and Mobility: Stick Hip Hinge
Intermediate Exercises: PHASE IIControlled Stabilization and Gait/Closed Chain
Weeks: 4 – 10 Gait
Stability
Closed Chain Activity
Goals
– Normalize gait
• Correct muscle imbalances
– Restore full range of motion
– Improve neuromuscular control, balance, and proprioception
– Initiate functional exercises maintaining trunk and pelvic stability
Intermediate Exercises: PHASE IIControlled Stabilization and Gait/Closed Chain